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J MSK > Trauma and fractures > Flashcards

Trauma and fractures Flashcards

1
Q

polytrauma definition

A 
trauma with more than on of; 
major long bone 
pelvis 
chest 
abdo region

…fractures

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2
Q

treatment of open fractures (5)

A 
broad spectrum antibiotics (flucloxacillin, gentamicin, metronidazole) 
sterile dressing 
tetanus injection 
debridement surgery
surgery to fix fracture
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3
Q

when describing a fractures displacement and angulation, which fragment are you referring to (distal or proximal)

A

distal

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4
Q

splintage examples

A

temporary plaster

sling

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5
Q

what is ORIF and when is it used

A

open reduction and internal fixation

surgery with intramedullary nails, pins, plates, screws etc

used for displaced intra articular fractures

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6
Q

when would you do joint replacement for a fracture

A

periarticular fracture with risk of AVN

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7
Q

what is external fixation and when would you do it

A

external brace with nails into bone

if there is swelling or unstable fracture, need swelling to be down to do surgery

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8
Q

is the bone remodeling rate the same in all bones

A

no changes depending on site

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9
Q

is bone remodeling quicker or slower in kids

A

quicker

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10
Q

when does primary bone healing take place (size of fracture + 2 examples)

A

fracture <1mm

hairline fractures
fractures fixed with screws

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11
Q

what cell is involved in primary bone healing

A

osteoblasts

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12
Q

what do osteoblasts do in primary bone healing

A

form a bridge over the fracture

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13
Q

when does secondary bone healing take place (instead of primary bone healing)

size of fracture

A

fracture >1mm

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14
Q

requirements for secondary bone healing (4)

A

oxygen
nutrients
stem cells
little movement (stabilisation with cast)

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15
Q

what are the 4 stages of secondary bone healing

A
  1. inflammation
  2. soft callus/bridging callus
  3. hard callus
  4. remodelling
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16
Q

in secondary bone healing, what cell is involved in stage 2. soft callus/bridging callus

what do they form

A

chondroblasts

cartilage

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17
Q

in secondary bone healing, what cell is involved in stage 3. hard callus

A

osteoblasts

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18
Q

in secondary bone healing, what happens in stage 4. remodelling

A

smoothing of bone

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19
Q

what is the most serious complication of fractures in limbs

A

compartment syndrome

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20
Q

what is compartment syndrome

A

broken bone = swelling of tissue = increased pressure in a limb compartment

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21
Q

what is the consequence of increased pressure in a compartment in compartment syndrome

A

occludes venous drainage = muscle ischaemia

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22
Q

how does compartment syndrome present (5)

A 
severe pain, worse on stretching of muscle 
swollen limb 
tender limb
loss of peripheral pulse 
cold
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23
Q

treatment of compartment syndrome

A

MEDICAL EMERGENCY

fasciotomy - open fascia to release pressure, leave open for a few days then fix problem

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24
Q

early local complications of fractures (5)

A 
vascular injury 
nerve injury 
compartment syndrome 
necrosis 
blistering
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25
Q

early systemic complications of fractures (5)

A 
hypovolaemia
shock 
ARDS
SIRS 
multi organ dysfunction syndrome
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26
Q

late local complications of fractures (3)

A

non union
volkmanns ischaemic contracture
complex regional pain syndrome

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27
Q

late systemic complications of fractures (1)

A

pulmonary embolism

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28
Q

what is volkmanns ischaemic contracture

aetiology

A

fibrotic contracture of muscle after fracture

aetiology - missed compartment syndrome

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29
Q

what is complex regional pain syndrome

A

swelling
stiffness
exaggerated pain response

in a sight of previous fracture

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30
Q

aetiology of atrophic non union after fracture

A

not enough blood supply
too big gap
drugs
infection

NOT MOVEMENT

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31
Q

aetiology of hypertrophic non union after fracture

A

movement or infection

think HYPER kids move a lot

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32
Q

are kids bones better or worse at remodeling than adults

A

better

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33
Q

what is a broken posterior rib in a kid a sign of

A

non accidental injury

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34
Q

‘bucket handle fracture’

‘corner joint fracture’ in kids

A

non accidental injury

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35
Q

long bone injury in kids

A

non accidental injury

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36
Q

if you ?non accidental injury in a kid <2, what investigation do you do

A

full skeletal survey

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37
Q

what is the classification of fractures in kids

A

salter harris classification

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38
Q

type I salter harris fracture

A

in kids
S traight along growth plate

(remember I = S in SALTEr)

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39
Q

type II salter harris fracture

A

in kids
A bove the growth plate (along the top then into metaphysis)

(remember II = A in SALTEr)

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40
Q

type III salter harris fracture

A

in kids
L ower than growth plate (goes along growth plate then down into epiphysis)

(remember III = L in SALTEr)

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41
Q

type IV salter harris fracture

A

in kids
T hrough growth plate (doesnt travel along is, cuts through it)

(remember IV = T in SALTEr)

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42
Q

type V salter harris fracture

A 
in kids 
E rosion (compression on growth plate)

(remember V = E in SALTEr)

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43
Q

greenstick fracture in kids (xray appearance)

where

A

when one side of the bone breaks but the otherside is intact

in ulna

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44
Q

tores fracture/buckle fracture in kids (xray appearance)

where

A

looks like a little nob on radius

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45
Q

where is a monteggia fracture

A

midshaft of ulna

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46
Q

where is a galeazzi fracture

A

midshaft of radius

gAleazzi = rAdius

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47
Q

which 2 fractures of the forearm are closely associated (if you get one youll probs get the other)

A

monteggia and galeazzi fracture

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48
Q

what joint is commonly affected in both galeazzia and monteggia fractures

A

distal radio-ulnar joint (DRUJ)

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49
Q

aetiology of supracondylar fracture

A

fall onto outstretched hand (FOOSH)

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50
Q

what nerve is commonly affected in a supracondylar fracture

how can its function be tested

A

median nerve

make ‘ok’ sign

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51
Q

aetiology femoral shaft fracture in kid <2

A

non accidental injury

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52
Q

treatment of femoral shaft fracture in <6

A

stabilise

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53
Q

treatment of femoral shaft fracture in >6

A

intramedullary nail (flexible 6-16, non flexible for >16)

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54
Q

are dislocations more common in males or females

why

A

females

more lax ligaments

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55
Q

treatment of hip fractures

A

pelvic hip binder/external fixator

56
Q

complications of hip fractures (5)

A 
internal iliac injury (blood loss = hypovolaemia) 
bladder injury 
nerve injury 
urethral injury 
pre-sacral venous plexus injury
57
Q

is it common to get 1 hip fracture

why

example

A

no

pelvis is a ring = will break in more than one place

eg open book pelvis

58
Q

investigations of pelvic fracture

A

PR exam - sacral nerve function
xray
CT

59
Q

who does pubic rami fractures occur in (2)

A

elderly

osteoporosis

60
Q

who does acetabular fractures occur in

A

RTA

elderly

61
Q

which group of people mainly get proximal femur fractures

A

elderly

62
Q

what is an intracapsular proximal femur fracture (location)

A

on or above the intertrochanteric line

63
Q

what is an extracapsular proximal femur fracture (location)

A

below the intertrochanteric line

64
Q

which type of proximal femur fracture (intracapsular or extracapsular) interfere with the blood supply to the femoral head

A

intracapsular

65
Q

how do proximal femur fractures present (apart from the obvious lol)

A

shortened and externally rotated

think about it - if it was dislocated (it presents the opposite) it would be internally rotated bc the femur will pop out of the socket

66
Q

what is the gardens fracture classification for

A

intracapsular proximal femur fractures

67
Q

xray appearance of intracapsular proximal femur fracture

A

not smooth shentons line (follow the inside of the femur into the inferior aspect of the superior pubic rami)

compare to the other side if unsure

68
Q

immediate treatment for proximal femur fracture

A

analgesia - WHO pain ladder

vit D

69
Q

surgery for intracapsular proximal femur fracture

A

surgery to sort out the joint (depends on age etc…)

70
Q

treatment of displaced intracpasular proximal femur fracture in active 60 year old

A

total hip replacement

71
Q

treatment of intracapsular proximal femur fracture in 90 year old in care home

A

hemiarthroplasty

72
Q

treatment of undisplaced intracapsular proximal femur fracture in active 60 year old

A

fixation with screws - get to keep their femoral head!

73
Q

treatment of extracapsular proximal femur fracture

A

internal fixation - dynamic hip screw or intramedullary nail

74
Q

complications of intracapsular proximal femur fracture (3)

A

non union
AVN
dislocation

75
Q

complications of extracapsular proximal femur fracture (1)

A

non union

NO RISK OF AVN BC NOT AT THE HEAD!

76
Q

prognosis of someone in a care home that falls and has proximal femur fracture

A

poor - will drop one level in mobility (stick to zimmer frame to wheelchair etc)

77
Q

aetiology of femoral shaft fractures

A

high energy - RTA

78
Q

treatment of femoral shaft fractures

A

Thomas splint

intramedullary nail - if unstable

79
Q

complications of femoral shaft fractures

A

BLOOD LOSS = hypovolaemia

80
Q

treatment of proximal tibial fracture

A

anatomic reduction and internal fixation (eg nails)

81
Q

treatment of proximal tibial fracture if there is swelling

A

external fixator until swelling goes down then internal fixation

82
Q

complications of proximal tibial fracture (3)

A

post trauma osteoarthritis
compartment syndrome
common peroneal nerve injury (= foot drop)

83
Q

what is a general complication of fractures around joints

A

post trauma osteoarthritis

84
Q

aetiology of a impacted tibial plateau fracture (on lateral condyle)

A

valgus force on a planted foot

eg car knocking over pedestrian

85
Q

what is also likely to break in a tibial shaft fracture

A

fibula shaft

86
Q

common complication of tibial shaft fracture

how do you prevent it

A

compartment syndrome

keep them in over night

87
Q

treatment of tibial shaft fracture

A

cast

intramedullary nail

88
Q

complication of proximal fibial fracture

A

common peroneal nerve injury (= foot drop)

89
Q

aetiology of ankle fractures

A

twisting forces

90
Q

what is the weber classification for

A

ankle fractures

91
Q

definition of stable ankle fracture

A

low in fibula BUT no medial malleolus fracture OR rupture of deltoid ligament

92
Q

definition of unstable ankle fracture

A

low in fibula AND medial malleolus fracture OR rupture of deltoid ligament (bruising)

CAUSES TALAR SHIFT

93
Q

what type of fracture cause talar shift

A

unstable ankle fracture

94
Q

treatment of stable ankle fracture

A

cast

95
Q

treatment of unstable ankle fracture

A

open reduction internal fixation (ORIF) surgery

96
Q

which metatarsal is most commonly fractured

A

5th

97
Q

where are stress fracture most common in the foot

A

metatarsal 2 and 3

98
Q

can you see all foot fractures on xray

A

no - may be too small!

99
Q

toe fracture treatment

A

boot/strap up

analgesia

100
Q

foot fracture treatment

A

moonboots

cast

101
Q

treatment of proximal humerus fracture (3)

A

SLING AND PHYSIO
joint replacement - if shattered bone
internal fixation - if young patient (causes stiffness in older people so avoided)

102
Q

humeral shaft fracture treatment (2)

A 
BRACE
internal fixation (intramedullary nail, screw etc) - if brace not tolerated
103
Q

complication of humeral shaft fracture

A

radial nerve injury = wrist drop and loss of sensation in first dorsal web space

104
Q

treatment of supracondylar fracture (2)

A

ORIF

joint replacement

105
Q

olecranon fracture aetiology

A

fall onto point of elbow

106
Q

complication of olecranon fracture

A

avulsion fractures - fragment tears away from rest of bone

107
Q

why are you likely to break your ulna (monteggia fracture) if you break your radius (galeazzi fracture)

A

they are in a ring

108
Q

treatment of one or both monteggia/galeazzi fractures

A

ORIF

109
Q

what is a dinner fork/swans neck deformity in the wrists name

A

colles fracture

110
Q

aetiology of colles fracture

A

fall onto outstretched hand (FOOSH)

111
Q

complications of colles fracture (3)

A

carpal tunnel syndrome from blood in compartment
extensor pollicis longus rupture
loss of grip

112
Q

what happens in a colles fracture

A

ulna??? displaced dorsally

113
Q

reverse colles fracture

A

smiths fracture

114
Q

fall onto back of hand/flexed wrist

A

smiths fracture

115
Q

fall onto outstretched hand (FOOSH) = wrist fracture

A

colles fracture

116
Q

treatment of smiths fracture

A

plates and screws (ORIF)

117
Q

intraarticular wrist fracture

A

bartons fracture

118
Q

bartons fracture treatment

A

plates and screws (ORIF)

119
Q

colles fracture treatment

A

splint - if stable

plates and screws - if unstable

120
Q

fracture dislocation at base of thumb

A

bennetts fracture

121
Q

complication of untreated bennetts fracture (thumb base)

A

arthritis at joint

122
Q

treatment of bennetts fracture (thumb base)

A

surgical stabilisation

123
Q

fall onto outstretched hand (FOOSH) hand fracture

A

scaphoid fracture

124
Q

presentation of scaphoid fracture

A

pain in anatomical snuffbox

125
Q

treatment of scaphoid fracture

A

cast

126
Q

which metacarpals do fractures typically occur in

A

3, 4 and 5

127
Q

what is a 5th metacarpal fracture characteristic of

A

boxers fracture

128
Q

treatment of boxers fracture (5th metacarpal)

A

make sure no misalignment

strap to finger next door

129
Q

complication of boxers fracture (if actually punched someone face and laceration)

A

septic arthritis

130
Q

phalangeal fracture treatment

A

strap to neighbouring finger

131
Q

cell proliferation in which bone layer causes increased girth

A

periosteum

132
Q

cell proliferation in which bone layer causes increased bone length

A

growth plates

133
Q

what does a sclerotic bone look like on xray

A

medullary density

featureless white bone

134
Q

which antibiotics are given prophylaxis in total hip replacement

what is the significance of this

A

coamoxiclav and amoxicillin

coamoxiclav = 4c antibiotic = c diff risk!

135
Q

treatment of ANY fracture with an open wound

A

debridement

then fix problem

136
Q

low impact undisplaced wrist fracture treatment

A

cast for 5 weeks (just needs stabilisation)

137
Q

most common salter harris fracture

A

type II - Above the growth plate (epiphysis)

J MSK (30 decks)

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